Western Photo Mount - Photo mats, photo mounts, old time photo and sports folders

Account Information

Business Name

Billing Address


Shipping Address


Phone

Fax

Email

URL

If a corporation or partnership, please complete this section

Corporation or partnership

Corporation Partnership

Federal ID #

Names of Principals

Type of Business

If an individual or sole proprietorship, please complete this section

Social Security #

Place of Employment

Position

Wife's name

Name of Employer

Account Information

Bank

Branch

Address


Phone

Fax

Account Type

Account Number

Officer

Officer's Phone

Name 2 business references with whom you have had open accounts within the past year

Name

Address

City, State, Zip

Phone

Account Number

Name

Address

City, State, Zip

Phone

Account Number

The undersigned hereby authorizes Western Photo Mount to contact the Credit Bureau and any other reporting agencies to secure information to complete this report. I/We agree to payment within the terms of 30 days, and also to payment of interest at 1.5% per month (18% APR) on all past due amounts. If collection and/or legal action is pursued by Western Photo Mount on any past due amounts, I/we agree to pay all collection fees, including attorney fees, both in collection and litigation if action is files thereon, and court costs related to such action.

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© 2008 by Western Photo Mount, Portland OR   •   Contact Us   •   Site Map   •   Privacy Policy   •   PDF Catalogs
11845 NE Marx St., Portland, OR 97220   •   Phone: 800-526-0901   •   E-mail: sales@westernphotomount.com
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